Atrial fibrillation management: evaluating rate vs rhythm control

ABSTRACT

Atrial fibrillation (AF) is an increasing global issue leading to increased hospitalizations, adverse health related events and mortality. This review focuses on the management of atrial fibrillation, in particular in the past decade, comparing two major strategies, rate or rhythm control. We evaluate the evidence for each strategy, pharmacological options and the increasing utilization of invasive techniques, in particular catheter ablation and use of implantable cardiac pacing devices. Pharmacological comparative trials evaluating both strategies have shown rate control being non-inferior to rhythm control for clinical outcomes of mortality and other cardiovascular events (including stroke). Catheter ablation techniques, involving radiofrequency ablation and recently cryoablation, have shown promising results in particular with paroxysmal AF. However, persistent AF provides ongoing challenges and will be a particular focus of continued research.

KEYWORDS:

• Atrial fibrillation
• rate control
• rhythm control
• pulmonary vein ablation
• antiarrhythmic medications
• amiodarone
• digoxin

Declaration of interest

P Leong-Sit has received consulting fees and speaker honoraria from Medtronic, St. Jude Medical and Biosense Webster J&J; and research salary support from the Canadian Stroke Prevention Network (in conjunction with the Heart and Stroke Foundation Canada and Bayer). R Yee has received consulting fees and speaker honoraria from Medtronic. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.